Author's School

Brown School

Author's Department

Social Work


English (en)

Date of Award

Summer 7-6-2023

Degree Type


Degree Name

Doctor of Philosophy (PhD)

Chair and Committee

Matthew Kreuter


Over the past two decades, the healthcare sector has increasingly sought to assess and address patients’ health-related social needs with the dual aim of health improvement and cost reduction. However, evidence for the health impact of social needs interventions is mixed. Most interventions are not guided by theories or conceptual models that specify causal pathways or mechanisms for how unmet social needs impact health. It is also currently unknown how social needs change over time and the timeframe over which social needs impact health outcomes. This dissertation seeks to fill these gaps by (1) critically reviewing existing conceptual models proposing mechanisms linking social needs and health outcomes; (2) exploring whether some social needs predict other social needs over time; and (3) empirically testing whether stress, sleep quality, or depressive symptoms are mechanisms that link social needs and cigarettes smoked per day longitudinally. Data on social needs, stress, sleep quality, depressive symptoms, and smoking were collected from a sample of 60 low-income women every three days over an 18-month period during the COVID-19 pandemic and were analyzed using multilevel dynamic structural equation modeling. The systematic review identified stress and negative affect (including depression) as two mechanisms that were included in most conceptual models. Analyses showed that increases in social needs predicted increases in stress and depressive symptoms in as few as three days. Housing-related social need predicted increases in other social needs such as food and transportation three days later. More research is needed to test mechanisms hypothesized to link social needs and health longitudinally. Improved conceptual models of social needs and health could inform new social needs intervention approaches. One promising avenue for social needs interventions could be to focus on addressing housing needs, which may free up individuals’ cognitive bandwidth and other resources to address other social needs on their own.

Available for download on Tuesday, December 31, 2024